Complications in Labor(HD) Flashcards
High Risk Pregnancy Factors:
Biophysical
- Genetics
- Nutritional Status
- Medical/Obstetrical history
High Risk Pregnancy Factors:
Psychosocial
- Smoking
- Caffeine
- Alcohol
- Drugs
- Psychological status
High Risk Pregnancy Factors:
Sociodemographic
- Low income
- no prenatal care
- age
- parity
- marital status
- residence
- ethnicity
High Risk Pregnancy Factors:
Environmental
-Exposure to teratogens
Fetal Status Tests(Ultrasound)
- visualizes fetal and maternal structures
- can be done transvaginaly
Fetal Status Tests(Amniocentesis)
- done 12-20 weeks
- genetic diseases
- quadruple screening
- fetal lung maturity
Fetal Status Tests(Non-stress test)
- external fetal monitoring
- reactive vs. non-reactive
Maternal Testing
-Maternal HGC for 02
-indirect coombs, test for RH
-triple screen(16weeks):
AFB=alpha fetal protein=neural tube defects=spina bifida
HCG=increase rapidly in beginning=hormone=rise in losing pregnancy
Estriol=High=down syndrome
-Glucose Screening
-Vaginal Culture
Hyperemesis Gravidarum(Etiology)
- a lot of vomiting during pregnancy
- excessive and difficult to alleviate N&V
- can happen to anyone young,old,obese,smoker
- morning sickness=no electrolyte imbalance
- hyperemesis=electrolyte imbalance
- antiemetics use cautiously; not in the beginning
Hyperemesis Gravidarum(s/s)
- weight loss
- dehydration
- electrolyte imbalance
- ketonuria
- acetonuria
Hyperemesis Gravidarum(tx)
- Rest
- IV fluids
- Antiemetics use cautiously
- severe cases-hospitalization-PPN or TPN
Hyperemesis Gravidarum(Nursing Care)
- I&Os
- smalls meals
- FHR
- VS
- Rest
- Assess for s/s of dehydration=poor skin turgor, dry mm, excessive thirst, dark concentrated urine
Incompetent cervix(Etiology)
- Painless, premature dilation of cervix
- Spontaneous abortions in obstetrical History
- under 14weeks: not able
- above 26weeks: age of viability
Incompetent cervix(Tx)
- Cervical Cerclage(closing opening surgically) if cervix is dilated more than 3cm and membranes intact
- Done between 14-26 weeks
- non-weight bearing recommended
Incompetent cervix(Nursing Care)
- Pt Education: explaining to mom why she should stay on bedrest
- emotional support
Bleeding Disorders
Early Pregnancy(before 24weeks)
- spontaneous abortions
- ectopic pregnancy
- hyditaform mole
Late Pregnancy(towards end of pregnancy)
- Placenta Previa
- Placenta Abruptio
Spontaneous Abortions(etiology)
loss of pregnancy before 20 weeks
-ruptured membrane 24-36hrs for fetal survival
-remaining tissue parts can lead to hemorrhage/infection/death
D & C=dilate cervix and move excessive tissue
Spontaneous Abortions(Threatened)
-vaginal bleeding, closed cervix, mild cramps
Spontaneous Abortions(Inevitable)
-cervical dilation, ruptured membranes, vaginal bleeding
Spontaneous Abortions(Complete)
- products of conception expelled
- uterine contractions
- bleeding
Spontaneous Abortions(Incomplete)
- profuse bleeding, retained tissue parts
- need D&C surgery to remove tissue parts
Spontaneous Abortions(Missed)
-fetus dies but retained, amenorrhea, foul smelling discharge or bleeding
Spontaneous Abortions(Septic)
-infection of uterus
Spontaneous Abortions(Habitual)
-3 or more consecutive loss of pregnancies
Spontaneous Abortions(Tx)
- Threatened-bedrest
- other-IV oxytocin(cause contraction)
- D&C
- Vacuum evacuation
Spontaneous Abortions(Nursing Care)
- vs
- I&O
- risk for hemorrhage
- Rhogam if Rh negative
- Emotional Support
Ectopic Pregnancies
- fertilization not in uterus
- not occupying uterine cavity
- increase w/ std’s
- ruptured appendix
- endometrosis
Ectopic Pregnancies(S/s)
- abd tenderness
- spotting
- bleeding
- decrease H&H
- increase WBC
- shoulder pain
Ectopic Pregnancies(Dx and Treatment)
- Trans Vaginal ultrasound
- methotrexate(antineoplastic; attack growth of cell)
- Salpingectomy(salpingectomy=salpinge aka removal of fallopian tube)
Ectopic Pregnancies(Nursing care)
- monitor s/s shock
- pre & post op care
- grief counseling
- pregnancy counseling
- monitor HCG levels
Hydatiform Mole(molar pregnancy)(Etiology)
- Abnormal trophoblastic tissue-avascular vesicles
- complete or incomplete
Hydatiform Mole(S/s)
- abnormal uterine growth
- PIH(pregnancy induced hypertension)
- HCG level
- excessive N/V
- vaginal bleeding
- no heartbeat
Hydatiform Mole(Dx and Tx)
- Transvaginal ultrasound
- D&C=dilation and curclage=scraping of wall of uterus
- rhogam
Hydatiform Mole(Nursing Care)
- assess for infection and hemorrhage
- patient education
- emotional support
Placenta Previa(Etiology)
-abnormal placement of placenta Types: -marginal=on side -partial=covering part of internal os -total=everything upside down, entire os is covered
Placenta Previa(S/s)
PAINLESS bleeding in 3rd trimester**
-goal for pt to reach 34 weeks=lung development
Placenta Previa(Tx)
- bedrest=no pressure of fetus on placenta
- C-section=possible vaginal delivery with marginal=requires C-section except possibly a marginal
Placenta Previa(Nursing Care)
- monitor FHR
- assess for hemorrhage
- assess fundus(bleeding behind fetus)
- emotional support for family
Abruptio Placentae(etiology)
- premature separation of placenta
- caused by physical/emotional trauma/car accident/fall down stairs/
- PIH(pregnancy induced hypertension)
- h/o abruption
- smoking/cocaine
- PROM(premature rupture of membrane)
Abruptio Placentae(s/s)
- PAIN**
- vaginal bleeding
- fetal distress
- hard uterus
- maternal shock
potential for:
- maternal shock/death
- fetal brain damage
- fetal demise
Abruptio Placentae(Tx)
- CBR-complete bed rest
- FHR
- Moms VS
- C/section
Pregnancy Induced Hypertension(Toxemia)
- PIH=after 20weeks
- no proteinuria
- B/P= increase 140/90
- increase of 30mm systolic
- increase of 15mm Diastolic
TX:
- monitor closely
- rest
- low salt diet
- high bp after 20weeks of pregnancy
- any mother w/Bp 140/90=PIH
- if increase of 30mm systolic=PIH
- increase 15mm diastolic=PIH
Pre-Eclampsia
-mild, severe
-HTN after 20weeks
-s/s=proteinuris edema of hands and face
-headache, blurry visiom
-damage to epithelium lining of vessels due to decrease in blood supply
-can lead to HELLP syndrome
HEMOLYSIS
ELEVATED LIVER ENZYMES
LOW PLATELETS
-elevated liver enzymes=increase in ammonia, not enough o2 to fetus
Pre-eclampsia(mild)(TX)
-limit activity
-possible complete bed rest lying on back or side lying
-anti-hypertensive
-pt education-often pt feels fine
-
Pre-eclampsia(Severe)(TX)
- hospitalization
- antihypertensive(concerned with hypotension)
- MagSO4=classic drug for eclampsia, decrese smooth muscle of body
- calcium gluconate=antidote for MagSO4
- Lasix=makes urine frequent, given because risk of fluid overload
- Amniocentesis=done in late pregnancy to see lung development
- decrease incidence of seizures as a preventative, prophalatic
Eclampsia(Etiology)
- s/s pre-eclampsia w/ SEIZURES
- p/f abruption
- fetal compromise, fetal death, maternal death
Eclampsia(S/S)
- seizures
- HTN, proteinuria(Large and excessive)
- decrease urine output, increase BUN and creatine(toxic)
- decrease platelets(lead to bleeding)
- visual problems(temp. blind)
- pulmonary edema(fluid in lungs)
- put on dialysis/ventilator
Eclampsia(Tx)
- multiple antihypertensive
- MagSO4=drug of choice for pre-eclampsia=can cause loss of deep tendon reflex
- excreted by kidneys must have good urine output and renal function
- give calcium gluconate if loss of deep tendon reflex
- foley in if less that 60cc/hr
- below 30cc/hr=stop magnesium sulfate
Eclampsia(Nursing care)
- quiet room
- VS
- I&O
- FHR
- increase protein diet
- monitor deep tendon reflexes
- side position
- seizure precaution(padded bedside, suction machine)
- suction at bedside
- emotional support
- mom Is at risk up to 48hrs after delivery
Blood incompatibility(ABO incompatibility)
- ABO incompatibility
- Mom=O(contains anti-A and Anti-B Antibodies)
- Fetus= A or B
- cause jaundice or hepatosplenomegaly
Blood incompatibility(Rh incompatibility)
- Mom=Rh-
- Fetus=Rh+
- leakage of antigens can occur during delivery
- first pregnancy no difficulty
- subsequent pregnancy antibodies attack
Blood incompatibility(Treatment)
- Rhogam(immunoglobulin) 72hrs after delivery
- may be given at 28weeks gestation
- pathological jaundice
- Rh (-) mother Rh (+) baby= problem
- rh- mom given rhogam
- given @28weeks and again 72hrs after birth
Gestational Diabetes(Etiology)
-abnormal metoblism caused be need for more insulin and increase in hormone(HPL)
Gestational Diabetes(s/s)
- rapid weight gain
- increase surgar in urine
- increase sugar in blood
- potential for DKA
Gestational Diabetes(effect on fetus)
- macrosomia
- neonate hypoglycemia
Gestational Diabetes(Tx)
- insulin
- daily bs
- frequent monitoring
- possible c-section
Gestational Diabetes(nursing care)
- pt education/nutrition
- usually resolves after delivery
Sickle cell
- avoid crisis
- potential for MI
- CVA
- PE during labor
- needs 02
Anemia
- monitor H/H
- iron supplement
- incerase iron diet
Cardiac
- maintain B/P
- limit activity during labor
- usual c-section
Infection
- cultures
- c/section to avoid transmission during delivery
Dystocia
-prolonged labor
-freidman curve:
used to graph dilation n descent
-potential problems:
infection
postpartum hemorrhage
exhaustion of mother
-can be related:
power-contraction
postiton of fetus
presentation of fetus
size of fetus
Dystocia related to contractions
Hypotonic
-weak ineffective contractions in active phase
-failure to progress contractions
treatment:
-amniotomy
-iv Pitocin(oxytocin)=increase uterine contractions
-possible c/section
Dystocia related to contractions
Hypertonic
-frequent strong contractions=uncoordinated in latent phase
treatment:
-sedative or medication to relax uterus
-brethine-relax smoothe musle of lung
-Procardia-regulate contraction of uterus
-MgSo4=drug of choice for eclampsia causes deep muscle tendon relax
-calcium carbonate is the antidote
Dystocia related to position,size,presentation:
Abnormal position
- posterior
- severe back pain
- may need forceps
- can rotate to normal position
Dystocia related to position,size,presentation::
cephalopelvic disproportion
- head too large or pelvis too small
- trial labor
- monitor bladder
- possible c/section
Dystocia(Macrosomia)
- large baby over 10lbs
- frequently with diabetic mother
- episiotomy, possible c/section
Dystocia(Abnormal Presentation/Breech):
- will try external version
- potential prolapsed cord and aspiration
- possible c/section
- (face)interferes with normal mechanism
Precipitous Labor
- completed within 3 hours
- strongs, frequent contractions
- potential fetal distress, perineal lacerations and hematomas
- precipitous delivery= multipara, do not leave alone
Induction of Labor
- stimulating labor before it naturally starts
- augmentation(adding)-accelerates or helps labor after it has started
- prostaglandins-cervival gel
- Laminaria-dried seaweed
- nipple stimulation, oxytocin from posterior pituitary
- walking-stimulates descent
Induction of Labor
- given in microdrops
- oxytocin: 10units/1000cc ringers
- stimulates uterine contractions
Induction of Labor(s/s of overstimulation)
- contractions closer than q2mins
- longer than 90sec=fetal distress
- rest less than 60sec=fetal distress
- possible fetal distress
- rupture of uterus
Induction of Labor(Contraindications)
- placenta abnormalities(placenta abrupt(premature rupture of placenta),placenta previa(misplaced placenta)
- abnormal presentations
- prolapsed cord
- fetal distress
- prior c/section with classic or low vertical incision
Amniotomy
-artifical rupture of membranes to stimulate or augment labor
-potential complications
umbilical cord prolapse
infection
abruption
Nursing Care:
-FHR
-monitor moms VS
-check amniotic fluid
Premature rupture of membranes
- before labor starts naturally and after 38weeks
- guidelines for premature rupture of membrane(72hrs or signs of infection fever 101F or higher)
- possibly caused by infection(chorioamnionitits or group B strep)
- Nursing Care:
- check pH of vagina using Nitrazine paper
- monitor VS
- Bedrest
- monitor Fetal status
Pre-Term Labor(Etiology)
- cervical changes after 20 weeks and before the end of 37 weeks
- low socioeconomic status
- young mother
- incompetent cervix
- poor nutrition, stress
- decrease blood supply to uterus
- abdominal trauma
- polyhydramnios(excess amniotic fluid in amniotic sc)
Pre-Term Labor(Nursing Care)
- Bedrest
- IV hydration
- tocolytics: to relax uterus and stop contractions
- betamethasone: to hasten fetal maturity and increase surfactant production in fetus
- care of infant-NICU-given surfactant to keep alveoli open to prevent RDS
Post term pregnancy
-pregnancy last longer than 42 weeks
-decrease placental perfusion risk of decrease 02 to the fetus
-may pass meconium
-decrease in amniotic fluid
-fetus keeps gaining weight
Nursing care and treatment:
-induction of labor
-c.section
